N I C H O L L S
S T A T E
U N I V E R S I T Y
STUDENT EMPLOYMENT TERMINATION FORM
Instructions:
This form must be used by all departments for all involuntary terminations. The completed form and the
last timesheet must be sent to the Financial Aid Office. The student will be paid for any time worked prior to
the termination on the next payroll date.
Name of Student
Campus ID Number
Department
Semester
Date of Termination
REASON FOR TERMINATION:
Signature of Supervisor
Date
Supervisor’s Name (printed)
Phone
Signature of Student Employee(optional)
Date
Revised 11/2006